HomeMy WebLinkAboutSWG2025-00433 - SWG Application / Design - 11/12/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00433
APPLICANT LOCK KELL RENEE & LARRY BRIAN Phone: 425-239-2935
JR
Address: P 0 BOX 431 SNOQUALMIE. WA 98065
OWNER LOCK KELL RENEE & LARRY BRIAN Phone: 425-239-2935
JR
Address: P 0 BOX 431 SNOQUALMIE: WA 98065
SEPTIC DESIGNER PAULA JOHNSON* Phone: 360-898-2255
Address: 171 E VUECREST DRIVE UNION, WA 98592
SEPTIC INSTALLER SHANE MAPLES* Phone: 360-463-8474
Address: 911 SE Arcadia Road SHELTON. WA 98584
Site Address: XX N Oxbow PI
Primary Parcel Number: 422095400059
Permit Description: New SFR 3-bedroom gravity system with bed drainfield
Permit Submitted Date: 10/28/2025
Permit Issued Date: 11/12/2025
Issued By: David Anderson
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/10/2028 (based on date of inspection)
Permit Conditions:
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
2 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
4 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
5 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
6 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
rntMASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
—f= Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
7 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
r .
OFFICIAL USE ONLY —
MASON COUNTY DHERECEIVED
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AMCVNi REC D. RECE QED B'' CO m
Public Health & Human Services �jCn
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Environmental Health 360-427-9670,ext.400 or 360-275.4467,ext.300 ��G ^ _ ^� - ^`[� 2 Cl) xi
415 N.6th Street Shelton,WA 98584 Q')-(•�>v�ZJI W + J z u)
ON-SITE SEWA E SYSTEM APPLICATIONE Po
m
PHONE m
APPLICANT
Kell Lock 4-•• .... (425) 239-2935 r- z
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MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE �� WA 98065 `D co
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P.O. Box 431ZQ 5no ualmie
S;TE ADDRESS-STREET,CITv,ZIP CODE � ti /7, Hoodsport WA 98548 C �'
10 N Oxbow PI �� , PHOw_ 3 I tV
NAME OF DESIGNER O • ❑
Arrow Septic Designs, In. Q (360) 898-2255
PHONE IDNAME OF INSTALLER f 463-8474 Z.
Maples Excavating t, (360) (7) I O
DRINKING WATER SOURCE 0
PERMIT TYPE(select ore)
RE RESIDENTIAL OSS Ia..COMMUNITY OSS E COMMERCIAL OS la;PRIVATE INDIVIDUAL WELL 67 PRIVATE TWO-PARTY WELL Z
7 PUBLIC WATER SYSTEM
'YPE OF WORK(Select Otte)
OR: - I
NEW CONSTRUCTION/UPGRADES a-REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR
0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINEco
SUBMITTALS
MI �z:
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REDESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1,2025? 0
WAIVERS)(IF APPLICABLE) 3 BR .35 ac El YES 2 NO 7 I i
O
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate)
Get on US-101 N toward Port Angeles. Turn (L) onto WA-119 N/N Lake Cushman Rd. Turn
(L) onto Clubhouse Way. Turn (R) onto N Fairway Dr W. Turn (R) onto N Mountain View Dr. 0 I 0
Turn (R) onto N Oxbow PI. Destination on (R). Yellow Sign "Lock"
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
O7 OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reposing purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER:
COMMENTS/CONDITIONS
INSPECTOR SOIL LOGS
101% Nfa
ti_t9 I 0 3t S 1 C 1 (otS (T'(P.v\1 botfoM
1 i H't!0-- Sv ~ l/ci trAti S fi) 6 ofkin1
TitS 1C-56 ' V6 , rid S
Ratct Si`• `""f v lrII•• RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES: ROOTSREQUIRED FOR FINAL APPROVAL.
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R= DATE
WSP-�'I,"SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY
11/to/zo?S 1 (80 (zozr [ I (IZ (zoi5 THIS F a RM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 2 0 9 — 5 4 — 0 0 0 5 9
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. ' Scaled layout sketch,including all applicable items on checklist.
"Scaled plot plan,including all applicable items on checklist. Cross-section sketch,including all applicable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Maximum paper size: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG a.Oa- --- Qo i-13g Designer's Name: Arrow Septic Designs, Inc
Applicant's Name:
Keli Lock Designer's Phone Number: (360)898-2255
Mailing Address:
P.O. Box 431 Designer's Address: 171 E Vuecrest Dr
Snoqualmie WA 98065 City State Zip Union, WA 98592
City State Zip Designer's Email paulaj hctc.com
DESIGN PARAMETERS
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU ❑Other
Treatment Level(check all that apply): ❑A ❑B 0 C ❑BL1 ❑BL2 ❑BL3 ❑E ❑N
Drainfield Type
'Gravity 0 Pressure 0 Trench liBed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 • Schedule/Class 2729
Daily Flow:Operating Capacity 270 gpd Length
45 ft
Daily Flow:Design Flow 360 . gpd Diameter 4 in
Septic Tank Capacity(working) 1,200 ( gal Number 3
Receiving Soil Type(1-6) 3 Separation 3 ft
Receiving Soil Appl.Rate 0.8 gpd/ft' Orifices
Required Primary Area 450 - ft2 Total Number of Orifices --
Designed Primary Area 450 ft2 Diameter -- in
Designed Reserve Area 450 , ft2 Spacing — in
Trench/Bed Width 10 . ft Manifold
Trench/Bed Length 45 - ft Schedule/Class 2729
Elevation Measurements Length 6 ft
Original Drainfield Area Slope 3 % Diameter 4 in
New Slope,If Altered 3 % Preferred manifold configuration used? EtrYes 0 No
Depth of Excavation Up-slope 14 in Transport Pipe
from Original Grade Down-slope 11 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length 40 - ft
Gravel-based Drainfield Required? Ig Yes 0 No Diameter 4 < in
Pump Required? 0 Yes efNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day —
Diff. in Elevation Between Pump& Uppermost Orifice — ft Dose quantity — gal
Drainfield Squirt Height/Selected Residual(head) — ft Chamber Capacity(flood) — gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head — gpm 0 Timer 0 Elapse Meter ❑ Event Counter
Calculated Total Pressure Head — ft If Timer: Pump on — ,Pump off —
Comments
Revised:4/14/2025
'1
DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 2 0 9 — 5 4 -- 0 0 0 5 9
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Ili Test hole locations 64 Drainfield orientation and layout Reference depth from original grade:
g Soil logs Bf Trench/bed dimensions and 61 Septic tank
Property lines critical distances within layout Fz1 Drainfield cover
❑ Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations 6 ' Laterals,trench/bed, top and
surface water and critical areas g Observation port location bottom
❑ Location and orientation of lig Clean-out location 0 Curtain drain collector
curtain drain and all absorption liff Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
0 Location and dimension of64 g Observation ports/clean-outs
primary system and reserve area Lateral placement with distance
to edge of bed Other Information
Buildings 0 Audible/visual alarm referenced Yes No
0 Direction of slope indicator
13 Scale of drawing shown on scale 0 11'Design staked out
g Waterlines bar 0 g Recorded Notices attached
g Roads, easements,driveways, O Elevation be _hmark and relative 0 [Waiver(s)attached
parking elevations . ii15 tern components 0 V Pump curve attached
g North arrow and scale drawing t 0 g Evaluation of failure
shown on scale bars Non-residential justification
e:•r•„ ,,, ,It 0 g Waste strength
y .,� • � 0 g Flow
*' : 4.. A
341ESI ►: 'PR
The undersigned designer must be notified Pal on g Yes ❑ No
E"P' ' C 0-2,1-Zs
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local on-site r ations:
// //?720 75 '.''-. 1//-- 4V1/
Environmental Health Specialist �'�Y ��..
P Date F,y y/,Q^,
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: 44
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✓ The design is stamped"Approved"by Mason County Public Health. yFti�T/,
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 1(/( ( 1j, '
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
Please Note: The system must be installed by a certified installer,
unless prior authorization is obtained from Mason County Public Health.
An Installation Fee is required.
This form may be scanned and available for public view on the Mason County Web site. Revised:4/14/2025
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of septic transport line. Maintain
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(Typical Bed Layout) k.` .
Note: '`��
0=Observation Port-to be 4"p..rforated . .
riPVC pipe from bottom of bed to finished
grade. A removable cap shall be installed on ;'V PAULA JOY JOHNSON '••
observation port pipe. Glue"T"on bottom 11:tZ .$ iib_E516).i
e so pipe can't be removed. Exa+R s-6ir
Minimum of 2 ;n system,one in each corner. 1.0 .,171.-
Laterals are to be centered in trenches. .p c�.
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ACCESS 1
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FROM SEINA6E FLOATING MAT
SOtlRCE
APPROVED
EFRAIEKT
FILTER
MOMENTS
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**Note: Septic Tanks must meet standards required by WAC chapter 246-272C
and manufacturer must be on the Dept of Health list of registered sewage tanks.**
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INSTALLATION & MAINTENANCE •a 1
Distribution Sstems - Bed '�� i "r '5106 i�
Gravity y Y PAULA JOY JOHNSON .
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1. Install Laterals with contour of the ground. EXPIRES :\I,5
2. Install bed bottom level. t A-2.1-ZS'
3. Install locator tape or rebar at each end of all drainfield laterals.
4. Install observation ports as indicated on the detailed drainfield layout. Minimum of 2
required at diagonal corners of bed drainfield with bottom extending to the
drainrock/native soil interface. Glue "T"to bottom so Observation Port cannot be easily
removed from ground. Install removable cap on top of port at final grade level.
5. Install drainfield during dry weather and soil conditions; any soil smearing must be
eliminated by hand raking.
6. Install riser over d-box with access to the surface.
7. Use distribution box with speed levelers. Divert incoming pipe down with 90-degree
angle to prevent short-circuiting.
8. Filter fabric required over drain rock prior to back filling. If the drain rock extends above
natural grade, run the filter fabric at least 2 inches down the trench wall.
9. Waterlines must be a minimum of 10' to any tank or drainfield(a reduction to 5' may be
obtained with a State waiver on lots that meet minimum lot size). Encase all water lines
within 10' of septic transport lines and under any driveway/parking areas.
10. Divert all storm water runoff away from on-site sewage system.
11.No curtain drains allowed within 10' of the up-slope edge or 30' of the down-slope edge
of the drainfield and reserve area.
12.No vehicular traffic over drainfield area or tanks.
13. Install Bio-Tube or equivalent effluent filter at outlet end of septic tank.
14. All manhole lids and access, sampling or inspection ports must have locking covers and
be located at ground level.
15. Inspect tank and clean filters every 6-12 months as needed.
16. Have the septic tank pumped or professionally inspected every 3 to 5 years.
17. All materials and workmanship must meet County and State regulations.
18. Deviation from this design without prior approval from the Designer and Mason County
Environmental Health Department will make this design null and void.
19. Homeowner is responsible for all property lines and easements.
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